Clinical implications of research on brief dynamic psychotherapy II. How the therapist helps or hinders therapeutic progress.

In this second of a two-part article, we describe how the therapist's interpretations promote therapeutic progress. Any therapist behavior that is in accord with the patient's plan will be helpful to the patient, but interventions that are at cross purposes with the patient's plan will not be helpful. The implications of the plan concept for brief dynamic therapy are described and contrasted with other key technical, concepts such as transference interpretations, therapeutic alliance, and interpretive activity. The importance of understanding the patient's plan and intervening in accord with it are illustrated in several case vignettes. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Role of perfectionism and personality disorder features in response to brief treatment for depression.

Using data from the Treatment of Depression Collaborative Research Program (TDCRP), the authors compared the role of patients' perfectionism and features of personality disorder (PD) in the outcome of brief treatment for depression. Data were extracted as to patients' intake levels of symptoms; perfectionism; and PD features, measured as continuous variables, as well as their symptoms at termination; their contribution to the therapeutic alliance; and their satisfaction with social relations. Poorer therapeutic outcome was demonstrated for patients with elevated levels of perfectionism and odd-eccentric and depressive PD features. Patients' contribution to therapeutic alliance and satisfaction with social relations were predicted by perfectionism but not by PD features. Results highlight the central role played by patients' personality in the course of brief treatment for depression. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Alliance and Dropout in Family Therapy for Adolescents With Behavior Problems: Individual and Systemic Effects.

This study examined the relationship between alliance and retention in family therapy. Alliance was examined at the individual (parent and adolescent) and family levels (within-family differences). Participants were 34 families who received functional family therapy for the treatment of adolescent (aged 12-18 years) behavior problems. Families were classified as treatment dropouts (n=14) or completers (n=20). Videotapes of the first sessions were rated to identify parent and adolescent alliances with the therapist. Results demonstrated that individual parent and adolescent alliances did not predict retention. However, as hypothesized, dropout cases had significantly higher unbalanced alliances (parent minus adolescent) than did completer cases. These findings highlight the importance of alliances in functional family therapy and suggest that how the alliance operates in conjoint family therapy may be a function of systemic rather than of individual processes. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Attachment to the therapist.

This study examines the ways in which therapists function as attachment figures for patients. Patients in long-term psychoanalytic therapy answered questionnaires about their feelings about their therapists and their closest personal relationships. Components of attachment prominent in the therapeutic relationships were looking up to the therapist and feeling the therapist was responsive to emotional needs. Stronger attachment to therapists was associated with greater frequency and duration of therapy, a stronger working alliance, and greater security of the patients' attachment style, as well as with the gender of the patient and therapist. Using attachment theory to understand psychoanalytic relationships emphasizes the unique importance of a therapist to a patient and can offer new perspectives on both therapeutic and attachment processes. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Process issues in treatment: Application to sexual offender programs.

How critical is the therapeutic alliance in the treatment of sexual offenders? To date such process issues have been neglected in the field of sex offender treatment. This article reviews the literature on the influence on behavior change of therapist features, clients' perceptions, and the therapeutic alliance. Among the many therapist features identified as helpful are empathy, warmth, and being directive and rewarding. Therapists who are aggressively confrontational appear not to foster beneficial changes in their clients. These issues are directly related to treatment issues faced by therapists who work with sexual offenders, such as dealing with cognitive distortions, lack of empathy, and lack of motivation to change. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Does the alliance cause good outcome? Recommendations for future research on the alliance.

Research has consistently documented that the quality of the therapeutic alliance is related to the outcome of diverse psychotherapies. Insufficient attention, however, has been directed at identifying the nature and magnitude of the causal relationship between the alliance and outcome. In this commentary, we discuss the major threats to causal interpretation of alliance-outcome correlations and provide suggestions for future research that would help clarify the extent to which the alliance causes positive outcomes. Assuming the alliance is a causal factor in relation to outcome, we provide recommendations for research on the alliance that would attempt to improve patient care by enhancing the alliance. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Maintaining the Safe and Effective Therapeutic Relationship in the Context of Distrust and Anger: Countertransference and Complex Trauma.

Prior research has shown that anger is a prominent feature in the psychopathology of trauma survivors. This hostile reactivity can be difficult for clinicians, who must balance instruction or interpretation designed to teach clients appropriate ways to handle anger and judicious withholding of response to maintain the therapeutic alliance for other purposes. Unlike studies that ask therapists to report their own mistakes, this research centers on advice given by 132 interview participants who had completed long-term trauma therapies. Clients generally reported greater satisfaction with trauma clinicians who were emotionally disclosing after angry episodes and who took partial responsibility for disagreements in therapy. Outcomes and satisfaction tended to be poor if therapists were "blank screens" in the face of anger. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Clients' pretreatment counseling expectations as predictors of the working alliance.

Because research suggests that counseling expectations are malleable and that alliance ratings predict clinical outcomes, the relationship between this pretreatment client characteristic (expectations) and the quality of the alliance early in treatment deserves further attention. This study examined the relationships between 57 clients' pretreatment role expectations and 3rd-session client-rated alliance in a naturalistic setting. Prior to intake, clients completed the Expectations About Counseling-Brief Form (H. E. A. Tinsley, 1982), and clients completed the Working Alliance Inventory-Short Form Revised (R. L. Hatcher & J. A. Gillaspy, 2006) following the 3rd therapy session. Results indicate that clients' expectations for personal commitment predicted the task, bond, and goal dimensions of the alliance. Expectations for facilitative conditions and counselor expertise did not predict clients' perceptions of the alliance. Clinical implications and research directions are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The Institutional Arrangements of Innovation: Antecedents and Performance Effects of Trust in High-Tech Alliances

In this study we investigate the institutional arrangements of innovation processes in high-tech alliances, focusing on the role of trust. A major strength of the research is the opportunity to address antecedents as well as performance effects of trust. The antecedents of interorganizational trust include a shared past, detailed interfirm contracts, relational openness and mutual dependence. We control for the size and cooperative culture of the focal firm and the knowledge value of the partner firm. Data from a field study of 391 Dutch firms in high-tech industries generally support the research model. The results provide convincing evidence to support the value of interorganizational trust in durable business relationships that strive for the development of new technological knowledge.